MECHANICAL VENTILATOR

Mechanical ventilation, or assisted ventilation, is the medical term

for artificial ventilation where mechanical means are used to assist
or replace spontaneous breathing.[1] This may involve a machine
called a ventilator, or the breathing may be assisted manually by a
suitably qualified professional, such as
an anesthesiologist, respiratory therapist, or paramedic, by
compressing a bag valve mask device
 USES

Mechanical ventilation is indicated when the patient's

spontaneous breathing is inadequate to maintain life.
Mechanical ventilation serves only to provide assistance for
breathing and does not cure a disease
Types of ventilators
Ventilators come in many different styles and method of giving a breath to sustain life.
There are manual ventilators such as bag valve masks and anesthesia bags that
require the users to hold the ventilator to the face or to an artificial airway and
maintain breaths with their hands. Mechanical ventilators are ventilators not requiring
operator effort and are typically computer-controlled or pneumatic-controlled.
Mechanical ventilators typically require power by a battery or a wall outlet (DC or AC)
though some ventilators work on a pneumatic system not requiring power.

•Transport ventilators — These ventilators are small and more rugged, and can
be powered pneumatically or via AC or DC power sources.
•Intensive-care ventilators — These ventilators are larger and usually run on AC
power (though virtually all contain a battery to facilitate intra-facility transport and as a
back-up in the event of a power failure). This style of ventilator often provides greater
control of a wide variety of ventilation parameters (such as inspiratory rise time). Many
ICU ventilators also incorporate graphics to provide visual feedback of each breath.
•Neonatal ventilators (Bubble CPAP) — Designed with the preterm neonate in
mind, these are a specialized subset of ICU ventilators that are designed to deliver
the smaller, more precise volumes and pressures required to ventilate these patients.
•Positive airway pressure ventilators (PAP) — These ventilators are specifically
designed for non-invasive ventilation. This includes ventilators for use at home for
treatment of chronic conditions such as sleep apnea or COPD.
 Types of Ventilator

Transport Ventilator
Bedside Ventilator

BPAP
Neonatal Ventilator
 Accessories

Humidifier

Ventilator trolley

Support Arm
 Oxygen Sensor

Flow Sensor
 Volume Modes

Assist-Control Ventilation (ACV)

Also known as continuous mandatory ventilation (CMV). Each breath is either
an assist or control breath, but they are all of the same volume. The larger the
volume, the more expiratory time required. If the I:E ratio is less than 1:2,
progressive hyperinflation may result. ACV is particularly undesirable for
patients who breathe rapidly.

Synchronized Intermittent-Mandatory Ventilation (SIMV)

Guarantees a certain number of breaths, but unlike ACV, patient breaths are
partially their own, reducing the risk of hyperinflation or alkalosis. Mandatory
breaths are synchronized to coincide with spontaneous respirations.
Continuous positive airway pressure
Continuous positive airway pressure (CPAP) is a non-invasive positive
pressure mode of respiratory support. CPAP is a pressure applied at the
end of exhalation to keep the alveoli open and not fully deflate. This
mechanism for maintaining inflated alveoli helps increase partial
pressure of oxygen in arterial blood, an appropriate increase in CPAP
increases the PaO2. CPAP is not technically a mode of "ventilation" as it
does not directly affect the minute volume.

Positive end-expiratory pressure

Positive end expiratory pressure (PEEP) is pressure applied upon
expiration. PEEP is applied using either a valve that is connected to the
expiratory port and set manually or a valve managed internally by a
mechanical ventilator.
Continuous spontaneous ventilation is any mode of mechanical ventilation where
every breath is spontaneous (i.e., patient triggered and patient cycled).
Spontaneous breathing is defined as the movement of gas in and out of the lungs
that is produced in response to an individual's respiratory muscles. In a nutshell,
spontaneous breathing is natural breathing. while at rest, a typical adult will take an
average of 18 breaths per minute. Most people are unaware of their breathing
patterns unless something interferes with the efficiency of this process. In extreme
cases, mechanical ventilation is used when spontaneous breathing is inadequate or
ceases entirely.

Bilevel positive airway pressure

Bilevel positive airway pressure (BPAP) is a mode used during non-invasive
ventilation (NIV).It delivers a preset inspiratory positive airway pressure (IPAP) and
expiratory positive airway pressure (EPAP). BPAP can be described as a Continuous
Positive Airway Pressure system with a time-cycle change of the applied CPAP level.
CPAP/APAP, BPAP, and other non-invasive ventilation modes have been shown to be
effective management tools for chronic obstructive pulmonary disease, acute
respiratory failure, sleep apnea, etc.
Often BPAP is incorrectly referred to as "BiPAP". BiPAP is the name of a portable
ventilator manufactured by Respironics Corporation; it is just one of many ventilators
that can deliver BPAP.
Introduction To ensure proper ventilator operation and
minimize risk of cross contamination, perform the following
cleaning and maintenance procedures at the recommended
intervals. All procedures should be adapted to your
institution’s policies and procedures. All personnel should use
precautions to minimize the risk of spreading infection when
disassembling, cleaning and performing maintenance
procedures on the ventilator system
Use of Filters
Inspiratory (To Patient) Port The gas that enters the breathing circuit
through the Inspiratory (To Patient) Port of the ventilator is usually
clean and dry; however, Newport Medical strongly recommends using
a filter at this port for two reasons:
1. To protect the inspiratory manifold from potential contaminants in
patient gases, and
2. To protect the patient from potential contaminant in the delivered
gas. By using the filter, the need for regular cleaning and
sterilization of the inspiratory manifold is reduced. By replacing
the filter between each patient use, the risk of infection being
spread between patients is reduced.
For cleaning/disinfecting the exterior surface of the
ventilator system, use a soft cloth that is moistened with a
cleaning/ disinfecting agent. Do not use harsh abrasives,
hard brushes, or cleaning/disinfecting agents that contain
phenols, ammonium chloride, chloride compounds, or more
than 2.4% glutaraldehyde.
Caution Plastic components should not come in contact with
the following solutions because they may cause
disintegration of the component:
1. Hypochlorite
2. Phenol (> 5%)
3. Inorganic Acids
4. Formaldehyde
5. Ketone
6. Chlorinated Hydrocarbons
7. Aromatic Hydrocarbon Caution Use only the cleaning
and sterilization methods specifically listed for each
ventilator component.
Consult accessory manufacturer’s guidelines for specific
cleaning, disinfecting, and sterilizing guidelines.
 TOOLS AND TEST EQUIPMENT NEEDED

SET OF SCREW +/-

SET OF PLIERS
SET OF ALLEN WRENCH
SOLDERING IRON
PPM KIT
SET OF WRENCH
PRESSURE METER
FLOW ANALYZER
OXYGEN ANALYZER
TIMER
TEST LUNG
BREATHING CIRCUIT
SAFETY ANALYZER
VENTILATOR TEST SYSTEM
PMS/CALIBRATION CHECKLIST
https://www.youtube.com/watch?v=d3bY1tBOMrg
 There are many things to be done for a ventilator during a Preventive Maintainance check-up,
most manufacturers recommend that a PM to be applied every 3 months of use, during which you will be prompted to do
some or all of the following:

•Inspect for any physical damage that might indicate mechanical damage or an abrupt mechanical damage.
•Run a full performance check, where you will check all modes of operation of the ventilator
•Change the air intake filter.
•Verify that all audible and visual alarms are working properly.
•Inspect labels.
•If there is a cooling fan filter then it is recommended to be inspected and cleaned every month (if you are in a dusty area you
might want to clean it more often).
•Some ventilators have an option to self-calibrate their oxygen sensor. This needs to be done often. (daily or as needed)
•If the ventilator has a collector vial then it needs to be cleaned and disinfected, in most cases, the collector vial can be sent to
the autoclave to disinfect it. (daily or as needed)
•Inspiratory and expiratory bacteria filters, if the filters are reusable then they should be autoclaved if they are disposable they
should be replaced after every patient, if the same patient stays connected to a ventilator for a long period of time usually
more than 15 days then the filters should be autoclaved or replaced whichever case is applicable, or after a circuit change.
You can check filter resistance in many types of ventilators, referring to operation manual will give you instructions on what to
do when the filter resistance increases above a certain level?
•Check if the battery is charging and that it is fully charged after long charge times. Usually, it is recommended to change a
ventilator battery every year, you can refer to the user/service manual of your ventilator to follow manufacturer
recommendations. 760 series Ventilators
•Check battery life by operating the ventilator on battery mode (by disconnecting the AC supply line then turning the ventilator
on, you can also check both audible and visible alarms indicating that a ventilator is using its battery power, then start
operation of the autoclave and commence your PM check. In some cases, a battery cable might be loosely connected. Do not
operate in battery mode for longer periods than recommended by the operation manual of the manufacturer.
•Some ventilator manufacturers allow for some parts to be chemically cleaned or treated.

CAUTION: Never send sensors of the ventilator for autoclave, usually flow sensors that are mounted on ventilator hose (to
more accurately measure air pressure) are "mistakingly" sent for an autoclave. Also, be noted that most manufacturers allow
autoclave temperatures 135 degrees Clausius in max. (i.e. 275 Fahrenheit).
Diagnostic Functions in Ventilators

Some Ventilators have self-test options, where applying such self-test, the ventilator will start a self-diagnostic checkup. This checkup can
aid in maintaining the machine as it will either give an error code number that is related to a defective part in the machine or it will tell you
what to do in order to resolve some minor problems. The self-test procedure varies from a manufacturer to another and the procedure to
apply such check is usually provided in the user manual of the ventilator. Most ventilators with self-test option have 2 self-check modes
where one is a short self-test (SST) the other is extended self-test (EST).
Short Self Test Mode
This test procedure needs to be done:
1. Between patients to make sure that critical ventilator components are not damaged,
2.Every 15 days,
3.Or when the breathing circuit is changed.
This mode will quickly test safety valves, flow sensors, solenoids, leak rate in the breathing circuit and measures circuit compliance. There
are fixed procedures to be done in order to be able to run the SST, one of which is that the patient circuit is already connected to the
ventilator. You may wish to see the operation/user manual for the ventilator before starting an SST.

Extended Self Test mode

This test mode will inspect the operational integrity of the ventilator with testing both electronics and pneumatic circuits of the ventilator.
The application of an EST is usually done if:
1.The ventilator needs servicing,
2.Or during a Preventive Maintenance performance verification
3.Or following a long idle period by which the ventilator was stored away.
For both self-test modes, it is highly recommended to follow the manufacturer's procedures that are provided in the operation/user manual.

In case a ventilator fails a self-test then it should NOT be used on a patient until it is serviced properly. During self-tests if there are some
problems in the ventilator then an error code number is usually displayed, these error code numbers are very important pieces
of information that need to be used while maintaining the ventilator, if you are not the person who is going to service the ventilator then it is
highly recommended that you send these error codes to the qualified person who is going to service it, as this will reduce downtime of the
machine and allow for better machine diagnosis.
What needs to be changed During a Routine PPM in a Ventilator?

As the ventilator is in service some parts might need to be changed, the interval of the parts that need to be changed is usually variable and might not
be needed to be done every 6 months (that is usually the PPM interval by which a ventilator needs to be checked)

Ventilator Internal Battery

Every 6 months the battery performance must be checked, this is done by having the ventilator work using the battery after it has been fully charged
and monitor its performance. Usually, the period at which the ventilator can work fully dependant on the battery is mentioned in the user/service
manual.

As a rule of thumb if the battery performance test passes then no need to change the battery, in some cases manufacturers might recommend
changing the battery every 1-2 years depending on the dependence on battery operation.

Ventilator Reusable Patient Breathing Circuit

The reusable patient breathing circuit will not last forever and based on manufacturer recommendations it has to be changed after a certain number of
autoclave cycles. This is mostly the task of the staff using the ventilator, not the biomedical team, but you have to make sure that the staff is following
manufacturer's recommendations on the number of autoclave cycles that after which the breathing circuit has to be changed, as if it is too frequent
then the hospital or clinic is losing money that could be used more wisely.

Whereas if the breathing circuit is not changed at all or beyond the recommended cycles, then this might lead to other problems, the simplest of which
is that there would be a leakage from a small crack in the circuit leading to a flow test error or other errors that can have the staff think that the
ventilator is not working properly, this would have them think that the ventilator needs to be checked and serviced. Which might become a major time
waste for the biomedical technician as he will be looking for a problem that is non-existent in the ventilator hardware and software.
Ventilator Oxygen Sensor

Usually, it has to be replaced after 1-2 years based on the manufacturer recommendation. It is very important to make sure the Oxygen sensors are
replaced during the recommended period, as the sensor will start to be not reliable and would lead to some error messages that can be prevented.
Preventive Maintenance Kit

Most ventilator manufactures have a PPM kit that includes various parts that need to be changed in a certain interval of time. Some manufacturers have
various kits for various periods of time. Usually, these parts kits have to bee change either periodically every 6 months 1 year or 2 years not based on the
number of hours the ventilator has been working.

Here the biomedical department should be aware of the kits that need to be replaced based on the working hours, as usual, these are overlooked if the
technician is not aware of them.

Fans and Fan Filters in the Respirator/Ventilator

Fans are vital for any electronic device as they are responsible solely for keeping the heat generated by various electronics parts away and thus making
sure that such electronic parts are not defected due to overheating.
So making sure that the fans are working is a very important preventive measure that can prevent the defect or failure of usually expensive electronic
boards.
Moreover, some filters are used especially to fans that are placed at the sides or rear parts that usually get air from the outside air to the inside of the
machine to cool the internal electronics of the ventilator, these fans have an added filter that is responsible for filtering dust particles from entering inside
the ventilator.

These filters overtime accumulate dust to a certain extent that they are not allowing proper air flow. So such filter needs to be either cleaned or replaced
based on the condition of that filter. Surely if you find a tear in the filter then a replacement is needed. usually, these filters are standard for most ventilators
and even the fans are standard as well, so replacing them would not be a problem.

Exterior Cleaning of the Artifical Ventilator

This step can be performed by the staff using the ventilator and not the biomedical technician, but you as a Biomed need to make sure that the cleaning
procedure that is recommended by the manufacturer is being applied and that if there is any standard procedure that the hospital or clinic recommend to
be applied as well.

Inspiratory Manifold and Exhalation Valve and Sensor in the Respiratory Machine

In the case that a ventilator operator has forgotten to connect the bacterial filter or viral filter then these parts need to be removed cleaned sterilized and
then be returned back to the ventilator. This process is time-consuming so making surer that best practices are applied saves effort and money while
maintaining best patient safety standards.

The steps of removing, cleaning, sterilizing and reinstalling these parts vary between models and thus it is best to follow the manufacturer service manual
to ensure best practices.

Fuses in the Ventilator

Any electronic device has fuses that are placed to protect sensitive electronic boards from electrical surges that might lead to defective parts. Fuses don't
need to be replaced unless they are blown or damaged. Sometimes there is an accumulation of carbonation at the sides of the fuse, in this case, you can
clean the carbonation and apply an electric contact grease that will enhance electric transmission and prevent future carbonation on the fuse.
OPERATIONAL VERIFICATION PROCEDURE

SETUP
Figure 6-1 Test Setup
1 Connect reusable adult patient breathing circuit to the ventilator to be tested.
Attach a test lung to the patient breathing circuit Y-Piece.
2 Connect the calibration analyzer with oxygen sensor between the main flow
outlet and the patient breathing circuit.
3 Connect regulated adjustable air and oxygen gas supplies to ventilator inlets on
the back of the ventilator. Set regulators to 50 psig.
4 Make a copy of the Test Record sheets or PMS/Calibration Checklist
ELECTRICAL SAFETY CHECKS
Ground Resistance Test

1 Connect the A.C. power cord to the EST analyzer.

2 Connect the ground lead of the EST analyzer to the labeled equipotential
connection on the back of the ventilator.
3 Perform ground resistance check and record the results on the OVP record sheet.
To pass, the ventilator ground resistance must be ? 0.1?.
OPERATIONAL PROCEDURE

Current Leakage test

1 Power the e360 ventilator ON.
2 Perform the current leakage check and record the result on the OVP record
sheet. To pass, the measured current leakage must be ? 100 µA.

OPERATIONAL CHECKS

Ensure the e360 ventilator Control Panel is adjusted to the settings

shown in Table 6-1.
NOTE: Adjustments are made with the Touch-Turn-Accept method.
 Control Setting
Patient Type Adult
Power ON
Breath Type Volume
Control Mode A/CMV
FI O2 .60
Flow 30 L/min
Tidal Volume 500 mL
Resp Rate 10 b/min
Pressure Limit 5
Pressure Support 0
PEEP 0
Trig Pressure Pressure 3.0 cmH2O
MVE Alarm Low at 1 L/min, High at 50 L/min
Pause 0 sec
Paw Alarm Low at 10, High at 75
Leak Comp. OFF
Circuit Type HVE